Intern Skills - General Physical Exam

Friday, October 25, 2013

This past week was spent finishing and polishing my presentation
for Grand Rounds titled "Safely managing prehypertension and stage
1 hypertension with botanicals." This is a subject that is close to
my heart if you will since hypertension and strokes are a common
occurrence on my father's side of the family.

Hypertension has been called the "silent killer" as a patient
may not notice any symptoms until a significant medical event such
as a stroke or heart attack occurs. A skilled, thorough doctor
performing a routine general physical exam can sometimes uncover
masked symptoms, which a patient may not even be cognizant about. A
well-performed physical exam can help prevent illness or even
prevent an early death.

At NUHS, we are trained on basic physical exam skills beginning
in our second of 10 trimesters. We are taught to fully examine the
patient through observation, listening, touch, and measurement. As
we progress through the curriculum, we build upon our basic
skillset and learn to interpret what we discover. This
interpretation is honed under the guidance of our clinicians in the
Whole Health Center and satellite offices.

Checking the internal components of the eye, as well as the
lens and cornea

Checking the ear, sinuses, nose, mouth, and throat

Listening to the patient's lungs and heart thoroughly

Testing muscle strength in the patient's arms, legs, hands, and
feet

Testing muscle reflexes in both arms and legs on each side

Testing patient's sense of joint awareness and planned
movements

Performing a full abdominal exam, listening for bowel sounds
(good)

Measuring the size of the liver and spleen through tapping and
listening for a change in sound

Listening for any abnormal sounds in any major arteries of the
body

This seems like a lot to do in one visit, especially if the
patient is in a hurry. We have the physical exam presented so
often, that by the time we are in clinic, we can perform this exam
in 30 minutes or less! This gives plenty of time for the remainder
of the patient visit and conversation. The general physical exam is
intended as a screening tool to determine if more focused
examinations are required for the patient. The physical exam
skillset we learn at NUHS helps us to target key systems with
quick, accurate examinations. When in practice as primary care
doctors, we will rely on this skillset each day with our future
patients. These skills will help us save lives.